|Table of Contents|

Transanal anastomotic reinforcement on anastomotic leakage after laparoscopic radical resection for middle and low rectal cancer

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 11
Page:
2048-2053
Research Field:
Publishing date:

Info

Title:
Transanal anastomotic reinforcement on anastomotic leakage after laparoscopic radical resection for middle and low rectal cancer
Author(s):
LIU Dong1; LIU Bin1; YANG Haoxiaoyu2; DUAN Xianglong1; LIU Sida1; WU Yunhua1; MAO Zhijun1; ZHANG Tao1; LONG Yanbin1
1.Second Department of General Surgery;2.Department of Neurosurgery,Shaanxi Provincial People's Hospital,Shaanxi Xi′an 710068,China.
Keywords:
laparoscopic surgery; middle and low rectal cancer; reinforcement on anastomotic; anastomotic leakage
PACS:
R735.3+7
DOI:
10.3969/j.issn.1672-4992.2023.11.014
Abstract:
Objective:To explore the feasibility of transanal reinforcement of anastomosis in laparoscopic radical resection of middle and low rectal cancer (Dixon) to prevent anastomotic leakage.Methods:From August 2019 to May 2022,127 patients with Dixon who underwent laparoscopic radical resection of middle and low rectal cancer were collected.According to the guidelines,the middle and lower rectal cancer was within the distance of the lower margin of the tumor from the anal 10 cm.The middle and low rectal cancer were divided into three groups according to the different ways of strengthening the anastomosis:Continuous transanal suture group (n=43),intermittent transanal suture group (n=42) and control group (n=42).The general data,operation time,intraoperative blood loss,first anal exhaust time,feeding time,postoperative hospital stay,anastomotic leakage,anastomotic bleeding,incision infection and perianal pain were compared.Results:There was no significant difference in general data among the three groups (P>0.05).Compared with the control group,there was no significant difference in operation time,intraoperative blood loss,feeding time,postoperative anal exhaust time,incision infection and perianal pain between the continuous suture group and the intermittent suture group (P>0.05).The anastomotic leakage was 4.65% in the continuous suture group and 4.76% in the intermittent suture group,and 16.67% in the control group.Although there was no significant difference among the three groups,it was suggested that transanal suture could reduce the incidence of anastomotic leakage.The postoperative hospital stay was (8.17±1.52) days in the intermittent suture group,(8.15±1.69) days in the continuous suture group and (12.13±1.57) days in the control group (P<0.05).There was no significant difference in postoperative hospital stay between the continuous transanal suture group and the transanal intermittent suture group (P>0.05).The number of grade C anastomotic leakage in the control group (3 cases) was higher than that in the transanal suture group (1 case).Conclusion:Laparoscopic middle and low rectal cancer radical surgery transanal continuous anastomosis reinforcement and transanal intermittent anastomosis reinforcement can reduce postoperative anastomotic leakage,simple technical operation,and shorten hospital stay,which can be widely used in clinic.

References:

［1］YANG Y,WANG HY,CHEN YK,et al.Current status of surgical treatment of rectal cancer in China［J］.Chin Med J (Engl),2020,133(22):2703-2711.
［2］中国结直肠癌诊疗规范(2020年版)专家组.国家卫生健康委员会中国结直肠癌诊疗规范(2020年版)［J］.中华胃肠外科杂志,2020,23(06):521-540. Chinese Colorectal Cancer Diagnosis and Treatment Standards (2020 Edition) Expert Group.National Health Commission Chinese Code for diagnosis and treatment of colorectal cancer (2020 edition)［J］.Chinese Journal of Gastrointestinal Surgery，2020，23(06):521-540.
［3］VARELA C,KIM NK.Surgical treatment of low-lying rectal cancer:Updates［J］.Ann Coloproctol,2021,37(6):395-424.
［4］TSAI YY,CHEN WT.Management of anastomotic leakage after rectal surgery:a review article［J］.J Gastrointest Oncol,2019,10(6):1229-1237.
［5］张忠涛，杨盈赤.腹腔镜直肠癌根治术难点与争议［J］.中华普外科手术学杂志(电子版),2018,12(01):1-4. ZHANG ZT,YANG YC.Difficulties and disputes of laparoscopic radical resection of rectal cancer ［J］.Chinese Journal of General Surgical Surgery(Electronic Edition),2018,12(01):1-4.
［6］LUO J,WU H,YANG Y,et al.Oxidative stress level as a predictor of anastomotic leakage after rectal surgery［J］.Mediators Inflamm,2021,2021:9968642.
［7］CHEN J,LIU Z,WANG Z,et al.Low ligation has a lower anastomotic leakage rate after rectal cancer surgery［J］.World Journal of Gastrointestinal Oncology,2020,12(6):632-641.
［8］XU H,KONG F.Malnutrition-related factors increased the risk of anastomotic leak for rectal cancer patients undergoing surgery［J］.BioMed Research International,2020,2020:5059670.
［9］ANDO K,KRUIYAMA N,FUJIMOTO Y,et al.New anastomosis technique to prevent anastomotic leakage in laparoscopic anterior resection for rectal cancer,especially upper rectal cancer［J］.In Vivo (Athens,Greece),2020,34(6):3533-3538.
［10］LUSHUN M,XINYUAN P,GUOFENG J,et al.The impact of anastomotic leakage on oncology after curative anterior resection for rectal cancer:A systematic review and meta-analysis［J］.Medicine,2020,99(37):e22139.
［11］BRUNNER M,ZU' BI A,WEBER K,et al.The use of single-stapling techniques reduces anastomotic complications in minimal-invasive rectal surgery［J］.International Journal of Colorectal Disease,2022,37(7):1601-1609.
［12］JIN SK,SUN YC,BYUNG SM,et al.Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique［J］.Journal of The American College of Surgeons,2009,209(6):694-701.
［13］NUH NR,JURGEN W,WERNER H,et al.Definition and grading of anastomotic leakage following anterior resection of the rectum:A proposal by the International Study Group of Rectal Cancer［J］.Surgery,2009,147(3):339-351.
［14］KURT AM,ANDREAS MK.Role of minimally invasive surgery for rectal cancer［J］.World Journal of Gastroenterology,2020,26(30):4394-4414.
［15］GAVRIILIDIS P,WHEELER J,SPINELLI A,et al.Robotic vs laparoscopic total mesorectal excision for rectal cancers:has a paradigm change occurred? A systematic review by updated meta-analysis［J］.Colorectal Dis,2020,22(11):1506-1517.
［16］SHIWAKOTI E,SONG J,LI J,et al.Prediction model for anastomotic leakage after laparoscopic rectal cancer resection［J］.Journal of International Medical Research,2020,48(9):300060520957547.
［17］ZHOU C,WU X,LIU X,et al.Male gender is associated with an increased risk of anastomotic leak in rectal cancer patients after total mesorectal excision［J］.Gastroenterology Report,2018,6(2):137-143.
［18］李昂，周毕军.老年直肠癌术后吻合口瘘的高危因素分析［J］.现代肿瘤医学，2019,27（19）:3468-3471. LI A,ZHOU BJ.Risk factors for postoperative anastomotic leakage in elderly patients with rectal cancer［J］.Modern Oncology,2019,27（19）:3468-3471.
［19］KIM CW,BAEK SJ,HUR H,et al.Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery［J］.Annals of Surgery,2016,263(1):130-137.
［20］蒋天宇，刘海山，马君俊，等.腹腔镜直肠双吻合术吻合口不同加固方式对吻合口瘘的影响［J］.上海交通大学学报(医学版),2020,40(07):951-956. JIANG TY,LIU HS,MA JJ,et al.Effect of different anastomotic reinforcement methods on anastomotic leakage in laparoscopic double rectal anastomosis ［J］.Journal of Shanghai Jiaotong University (Medical Edition),2020,40(07):951-956.
［21］WU Z,VAN DE HAAR RCJ,SPARREBOOM CL,et al.Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis［J］.International Journal of Colorectal Disease,2016,31(8):1409-1417.

Memo

Memo:
陕西省重点研发计划-社会发展领域资助项目(编号：2023-YBSF-420)；陕西省创新能力支撑计划（编号:2019GHJD-14);陕西省西安市社会发展引导计划-医学研究项目［编号：2017113SF/YX007(12)］
Last Update: 2023-04-28